The problem is we cannot get the HMO to give us a skilled rate.  After our begging and pleading they are taking two to three weeks before giving us a response that they are denying our request for skilled rate.
 
We had a fresh hip fracture requesting skilled rate and they denied.  That is why I need to know what rules are HMo's suppose to follow in regards to who they give skill rates to and who they do not.
Dawn Sheppard, RN, CRNAC
----- Original Message -----
Sent: Monday, February 02, 2004 6:38 PM
Subject: Re: HMO

In a message dated 2/2/2004 7:30:50 PM Eastern Standard Time, [EMAIL PROTECTED] writes:


What rules do HMO have to follow in regards to skilling a resident?  Does anyone know where I can find this information?.

Dawn Sheppard, RN, CRNAC


I have found that adhering to medicare rules for skilling and documentation is satisfactory.  We call weekly with report to the hmo, who then either recert for another time period, usually a week, or let us know that we are approaching or have approached the time where they will not pay for the services.
GJ Ferlick, RNAC
Ambler Rest Center
Ambler, PA

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